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Managed Care May 2007	Self-Referral Persists Despite Stark II Law Loopholes in federal and state laws that curb physician referral to diagnostic imaging providers in which they have a financial stake (self-referral) are allowing physicians to stretch how they are paid and for what.
Managed Care June 2005	Quick Results, Not Self-Referrals, Fuel Increase in Imaging Tests The researchers say that if self-referral were an important driver of the number of imaging services, they would have seen an acceleration in the growth of imaging services from 2001 to 2003 to offset the reductions in physician income brought about by reductions in the conversion factor.
Managed Care November 2007 Tom Reinke	New Imaging Controls Strict, But May Be Easier on Doctors Preauthorization procedures for costly new imaging technologies aim to help doctors learn the rules to avoid denials.
Managed Care January 2005 Maureen Glabman	Health Plans Strain To Contain Rapidly Rising Cost of Imaging PET, CT, MRI -- these and other imaging technologies are valuable but costly. Aetna, Cigna, and a few other plans lead in clamping down on unnecessary use.
Commercial Investment Real Estate Sep/Oct 2009 Andrew Dick	Deal Diagnosis Healthcare real estate transactions not only are driven by economic factors, but also by compliance with federal and state healthcare laws.
Managed Care April 2000 Michael Levin-Epstein	Congressional Anti-Kickback Battle Hinges on HCFA's Regulatory Stance In an election year, the political hot buttons -- the Patients Bill of Rights and a Medicare prescription benefit, and maybe the issue of medical errors -- are sure to get a lot more attention than such mundane things as laws that would address potential kickbacks....
Managed Care March 2001 Mark D. Abruzzo	'Final' Stark Regulations Still a Work in Progress The Stark Law generally prohibits physicians from referring Medicare patients for certain designated health services to entities with which the physician (or immediate family members) has a financial relationship...
Managed Care January 2006 Martin Sipkoff	Old Techniques Never Die, Nor Even Fade Away Urged on by employers traumatized by costs, health plans are renewing their interest in prior authorization, but using a lighter hand.
Managed Care July 2001 John Otrompke	Stark Allows Federal Regulators To Review Claims Records Fully HMO executives, as well as the providers and physicians who contract with them, should have by now felt the changes in their daily work lives resulting from the government's increased scrutiny of health plans' operations under the fraud-and-abuse compliance laws...
Managed Care October 2005 Bob Carlson	What Docs Hate Most About Plans Some insurers seem to have a knack for irritating their network physicians. The list is long, but five categories of irritants seem to recur most often.
Managed Care August 2000 Bob Carlson	'All Products' Clauses Fade From Physician Contracts All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others.
Managed Care December 2007 John Carroll	How Doctors Are Paid Now, And Why It Has to Change Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn't had much effect on its use.
Pharmaceutical Executive September 1, 2013 Shantanu Agrawal	Making Sense of the Sunshine Act: A New Era for Drug Promotion Now that the Sunshine Act's Open Payments spending disclosure program is live, the federal government's lead officer for compliance explains how the new web-based system will work and how US industry, providers, and patients will be better off by making their relationships fully transparent.
Managed Care December 2000 Maureen Glabman	Downstream Without a Paddle State legislatures that tackle medical group insolvencies have come up with strategies that sometimes shift accountability to HMOs...
Managed Care April 2000 Mark Abernathy	Avoid Common Problems In Risk-Sharing Contracts These arrangements too often become a hindrance instead of a help. Simple precautions today can help prevent major headaches later on.
Pharmaceutical Executive March 1, 2011 Jerry Coamey	Engage the Physician! New research shows that gauging the mind of the clinician is crucial to timely uptake of the new diagnostic tools offered by the genomic revolution
Managed Care July 2006 Lola Butcher	Oncologic PET Study Seeks Basis for Coverage Decisions The launch of a new registry that will significantly expand Medicare's coverage of positron emission tomography may bring new clarity on appropriate uses for this technology -- and even more pressure on commercial health plans to cover the high-cost scans.
Commercial Investment Real Estate May/Jun 2014	Medical Office Fever Sales of medical office buildings topped $6.7 billion in 2013, according to Real Capital Analytics, proof that this niche sector remains attractive to investors.
Managed Care December 2001 Michael S. Victoroff	Risky Business When Public Plays Doctor With Open-Access MRI As a physician, a health plan medical director, and a citizen, I wonder at medical diagnostic arcades proliferating like sushi bars...
Managed Care April 2000 Karen L. Trespacz, J.D.	League of Their Own: What Makes a Winning IPA? In a familiar cartoon, a professor writes long, learned equations on a blackboard. To connect the profundities on either end, he writes in the middle, "Then a miracle occurs." IPAs, done well, are the miracles that connect the ends of health care.
Commercial Investment Real Estate Mar/Apr 2007 J. Michael Davis	MOB Outbreak The fast-spreading healthcare industry makes medical office buildings a lucrative investment for physicians.
Managed Care May 2004 MargaretAnn Cross	Will Providers Seek New Contracts As Consumer-Directed Plans Grow? Although plans are not restructuring fee schedules in consumer-directed health plans, providers think their agreements need fine-tuning.
Managed Care January 2002 Michael Levin-Epstein	HHS Seems To Soften Hard Line on Kickbacks Do two recent advisory opinions from the Health and Human Services Office of the Inspector General signal some moderation in federal policy on what constitutes a kickback? Maybe. Or then again, maybe not...
Managed Care December 2002 Diane Cook	Beware the Hidden Consequences of the Malpractice Crisis Soaring malpractice insurance rates are thinning out provider ranks in at least a dozen states. Could access problems pose issues for HMOs in those areas?
Managed Care January 2005 Alice G. Gosfield	P4P: Transitional at Best Pay-for-performance (P4P) programs promise a fair shake for provider and insurance plan, but a former chairman of the National Committee for Quality Assurance sees many design flaws to overcome.
Managed Care July 2001 Harry L. Leider	HMOs Need To Share Gains of DM Programs Physicians are more likely to buy in if they see better outcomes -- and financial rewards that go with them...
Pharmaceutical Executive May 1, 2006 Musacchio & Hunkler	More Than a Game of Keep Away The Prescribing Data Restriction Program takes effect in July. The AMA explains how individual doctors can keep their prescribing habits safe from reps, and how pharma can keep using the anonymous data -- if the industry polices itself.
Managed Care June 2007 MargaretAnn Cross	What the Primary Care Physician Shortage Means for Health Plans Insurers fear rising costs and poorer outcomes if members are less able to get appointments with family physicians and general internists.
Managed Care October 2000 Maureen Glabman	Giving Some Ground to Physicians Helped Turn Health System Around One hospital system accepted the general wisdom a few years ago by acquiring physician practices. Now it bucks the new wisdom by holding on to them...
Commercial Investment Real Estate Jul/Aug 2012 Wassik & Carlson	Medical Office Trends Hospital affiliation is a strong indicator of MOB asset value.
Managed Care September 1999 Ed Rabinowitz	Is There a Doctor in the House? The per-visit cost of a house call is high, but used judiciously, this practice can lower overall medical costs -- not to mention provide better care.
Managed Care June 2002 John Carroll	States May Become Battleground In Push for Collective Bargaining Physicians at a local Texas hospital gained certification as a bargaining unit, and approached a managed care company to negotiate pay, but the effort failed. A new bill would allow physicians to ease toward collective bargaining nationwide.
Managed Care March 2005	Family practice base salary continues to improve Base salaries of family practice physicians increase.
Financial Planning August 1, 2008 David A. Twibell	House Calls Working with physicians can be rewarding, but to be successful, advisors need to develop the skills to tackle the unique problems facing doctors.
American Family Physician November 15, 2005 Sarah J. Evans	Newsletter AAFP Survey Shows Increased Use of EHR Systems by FPs... AHRQ Launches New Health Care Program... AAFP Asks Members to Join Title VII Campaign... AHRQ Rewards Over $22.3 Million for Health Information Technology... etc.
Managed Care June 2005 Martin Sipkoff	The Re-Emergence of the Primary Care Physician A new model of care developed by the American Academy of Family Physicians places primary care physicians back at the center of care delivery.
Managed Care December 2005 Ricardo Guggenheim	Putting EBM To Work (Easier Said Than Done) Through widespread implementation of evidence-based medicine, the United States has its best chance of erasing the variations in care that currently extract such huge costs -- both human and financial -- from the health care system.
Managed Care August 2001 John Carroll	Info on Questionable Physicians Languishes in National Data Bank A clearinghouse was created that stores details about malpractice suits and disciplinary actions. So how come HMOs don't use it?
Managed Care May 2006 Michael Levin-Epstein	Looking for a Better Way To Manage Care Can primary care physicians persuade health plans and Medicare to accept their version of the chronic care model?
Pharmaceutical Executive January 1, 2013 Al Topin	The Doctor-Patient Disconnect Doctor-patient conversations aren't always what we think; this basic interaction represents both a problem and an opportunity for today's drug marketers, says the author.
Managed Care November 1999	U.S. Supreme Court To Hear Suit Against HMOs Over Incentives Can HMOs be sued for the practice of offering bonuses to physicians who help them keep the cost of care down?...
Managed Care August 2001	GAO: Consultants Point Docs Toward Federal Law Violations The General Accounting Office has found that some health care consultants have been advising physicians to do things that conflict with federal laws and that may be unethical...
AskMen.com Tara Weiss	Reasons Not To Become A Doctor There were once many rewards to being in the medical profession. For decades, doctors earned hefty paychecks, had autonomy and respect. Those benefits are fading, and as a result, so is the number of doctors.
Managed Care March 2006 Taylor & Eck	It's Time for CMS to Release Physician Medicare Claim Information The Center for Medicare & Medicaid Services is a rich source of price and quality data. Isn't it about time it shared that data?
Pharmaceutical Executive July 1, 2011 Cabacungan & Clark	New Ways to Gain New Brand Insights If you can learn to understand patient and physician behavior, you are well on your way to strengthening the position of your product.
Managed Care June 2001 Frank Diamond	HMO/Physician Strain Creates Invisible Costs Perhaps goodwill is too much to ask for. However, peaceful coexistence can certainly help all players reach their mutual goal -- a smooth relationship that helps to get the job done...
Managed Care May 2004 Martin Sipkoff	Will Pay for Performance Programs Introduce a New Set of Problems? Paying incentives to physicians to practice evidence-based medicine appears to be an idea whose time has come. Such programs -- even if successful -- may create a new set of problems.
Managed Care December 2003 Frank Diamond	Dr. Do-Good and Mr. Bottom-Line How medical directors reconcile the contradictory demands of physician and executive roles.
Managed Care May 2007 David A. Sparrow	Pay for Performance: As Much About Costs as About Quality You don't really have a true pay-for-performance program if it doesn't say so on the bottom line.
Managed Care March 2005 William F. Jessee	What Do Physicians Want From Health Plans? Standardizing health plan administrative processes and eliminating duplication of effort would go a long way toward strengthening the doctor-insurer relationship.